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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005685
Report Date: 11/20/2023
Date Signed: 11/20/2023 10:28:34 AM

Document Has Been Signed on 11/20/2023 10:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:BC CARE 2FACILITY NUMBER:
306005685
ADMINISTRATOR:CHANG, BUJAFACILITY TYPE:
735
ADDRESS:1301 S. WALNUT STREETTELEPHONE:
(714) 519-3895
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY: 4CENSUS: 4DATE:
11/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Buja Chang - AdministratorTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived for an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry by DSP Susan Cobrado. Administrator Buja Chang joined the inspection during the tour.

The facility is a one-story home with four resident bedrooms, three bathrooms, kitchen, dining room, living room, family room, staff room, back yard and attached two-car garage. Facility appeared clean, sanitary and well-organized. All resident rooms had required elements, including bed, chair, closet space and ample lighting. Restrooms are stocked with soap and paper towels. Hot water measured at 109.6 degrees Fahrenheit in the bathroom nearest to the front door, 116.6 degrees Fahrenheit in the bathroom located inside of one of the room nearest the front of the house and 117.8 degrees Fahrenheit in the bathroom nearest to the back of the house. Facility has a supply of extra linen stored in the hallway. LPA observed exit gate in the backyard to be operational and unobstructed. Facility has two shaded seating areas in the backyard and one shaded seating area in the front yard. Smoke and Carbon Monoxide detectors tested operational. LPA observed facility has emergency food and water supply. Laundry machines are stored in the garage and operational. Fire Extinguisher was observed to be fully charged as indicated by the built-in meter. The service tag indicates it was last serviced on 12/06/22. LPA reviewed medication and files for two out of the four clients. LPA reviewed three staff files. Medication and files are stored in a locked cabinet in the dining room. All residents were away at day program at the time of inspection.

No deficiencies were noted during today's visit. An exit interview was conducted and a copy of this report was provided to the administrator.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Dwayne L Mason
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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